Provider Demographics
NPI:1346570736
Name:RIVERS, WENDY S (LPN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:RIVERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DEER RUN DR APT A
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-1074
Mailing Address - Country:US
Mailing Address - Phone:518-307-8088
Mailing Address - Fax:
Practice Address - Street 1:9 DEER RUN DR APT A
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-1074
Practice Address - Country:US
Practice Address - Phone:518-307-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2692551164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse